Hypoalbuminemia and invalidating edema in an elderly subject: treatment with parenteral albumin infusion

Many factors can lead to edema. Hypoalbuminemia and the inability of the renal distal tubule to excrete salt are a common cause of edema, that can be due to a defect of albumin synthesis or malnutrition, kidney disease, protein-losing enteropathy, or increased protein catabolism. Hypoalbuminemia is frequent amongst elderly people. Its prevalence ranges from 4% to 50% depending on whether they live at home or in hospice. In normal circumstances, albumin has a double function to maintain oncotic pressure and to transport endogenous or exogenous substances. Lack of albumin is thus responsible for numerous pathological states. In this article, we report two clinical observations in patients aged over 65, suffering from generalized, highly invalidating edema, with low albumin states due to malnutrition. A rapid long-term recovery was observed after administrating albumin, and produced a far better quality of life for the patients. The clinical results obtained following this specific indication warrant further research work to verify their scientific validity on a larger scale.     

Gene expression profile analysis of AIDS-related primary effusion lymphoma (PEL) suggests a plasmablastic derivation and identifies PEL-specific transcripts

AIDS-related primary effusion lymphoma (PEL) is an HIV-associated malignancy characterized by the ability of the tumor cells to specifically home in the serous body cavities. Here we used gene expression profile analysis (about 12 000 genes) to further define the phenotype of PEL and to investigate the lymphoma relationship to normal B cells and to other tumor subtypes, including non-Hodgkin lymphomas (NHLs) of immunocompetent hosts and AIDS-associated NHL (AIDS-NHL). The results showed that PEL displayed a common gene expression profile that is clearly distinct from all NHLs of immunocompetent hosts and AIDS-NHL subtypes and, in contrast to those, is not related to germinal center (GC) or memory B cells. The gene expression profile of PEL was defined as plasmablastic because it showed features of both immunoblasts identified by Epstein-Barr virus (EBV)-transformed lymphoblastoid cell lines and AIDS immunoblastic lymphoma, and plasma cells, as defined by multiple myeloma cell lines. Finally, our results identify a set of genes specifically expressed in PEL tumor cells. Their expression was validated at the protein level, suggesting their potential pathogenetic and clinical significance.     

High-dose cytarabine as consolidation treatment for patients with acute myeloid leukemia with t(8;21)

Seventeen patients affected by acute myeloid leukemia (AML) with t(8;21) were prospectively programmed to receive three courses of high-dose cytarabine (HDARA-C) as post-remission therapy. The median age was 39 years and in all cases t(8;21) was the only karyotypic abnormality. Complete remission (CR) was achieved in 14 out of 17 cases (82%) and, after first consolidation with NOVIA regimen (intermediate dose ARA-C plus mitoxantrone), all patients received the three planned courses of HDARA-C (3g/m(2) q12h on days 1, 3, 5). There were two documented infections, while all patients experienced fever of unknown origin (FUO). Nonhematological toxicity was mild. Thirteen out of 14 patients are in continuous CR after a median follow-up of 44 months. One patient relapsed at 16 months and, following CR2 achievement, underwent allogeneic transplantation; he died 3 months later while in CR from acute graft versus host disease (GVHD). Survival at 5 years is projected at 79%. Our data confirm the efficacy of repeated courses of HDARAC for patients with t(8;21) AML.     

History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study

To evaluate the association between history of childhood attention deficit/hyperactivity disorder (ADHD) symptoms and the diagnosis of borderline personality disorder (BPD) in adulthood, the Wender Utah Rating Scale (WURS) was administered to 42 consecutively admitted BPD subjects, 94 consecutively admitted controls with any cluster B personality disorder (PD) diagnosis other than BPD, 38 consecutively admitted controls with any cluster A or cluster C PD diagnosis but no cluster B PD diagnosis, and 69 consecutively admitted controls with no PD diagnosis. A fourth control group was composed by 201 nonclinical volunteers. According to Dunn-Bonferroni contrasts, BPD subjects showed a significantly higher mean WURS total score compared to all control groups (minimum t = 7.93, maximum t = 11.63, all Ps <.001). These contrasts remained significant even controlling for potential confounders such as antisocial personality disorder (ASPD) diagnosis, gender, inpatient status, and axis I diagnoses. The results of this study seem to support the hypothesis of an association between history of childhood ADHD symptoms and adult BPD diagnosis.     

Tamoxifen is not effective in good prognosis patients with hepatocellular carcinoma

Background  

Large randomised clinical trials and systematic reviews substantiate that tamoxifen is ineffective in improving survival of patients with hepatocellular carcinoma (HCC). However, a recent report suggested that the drug might prolong survival among patients with well preserved liver function. The aim of this paper is to validate this hypothesis.     

Dietary therapy in diabetic pregnancy: recommendations

As a further elaboration of our systematic definition of nutritional therapy in diabetic patients, this booklet looks at the delicate but very important question of the diabetic woman’s diet during pregnancy. The recommendations were drafted by diabetologists and nutritionists who have specifically studied the problems of nutrition in pregnancy, and are backed by the Italian Association for Clinical Dietetics and Nutrition (ADI), the Association of Medical Diabetologists (AMD), and the Italian Society for Diabetology (SID). The synergism of this joint effort has produced a document that we sincerely hope will help all members of teams who tackle this vital issue in diabetes in their daily work.     

High incidence of monoclonal EBV episomes in Hodgkin's disease and anaplastic large-cell ki-1-positive lymphomas in HIV-1-positive patients

A series of selected lymphoid malignancies (LMs) occurring in Italian HIV-1-infected (HIV⁺) patients, principally intravenous drug users, was investigated. In addition to small non-cleaved-cell (SNCC) and large-cell immunoblastic (LCI) non-Hodgkin's lymphomas (NHLs), a relatively high occurrence of anaplastic large-cell Ki-1-positive (ALC Ki-1⁺) lymphomas and Hodgkin's disease (HD) was observed, at variance with other reported series of HIV⁺ patients. Combined results of in situ hybridization and Southern-blot analyses, in conjunction with immunohisto-chemical detection of Epstein-Barr virus (EBV)-encoded latent membrane protein-1 (LMP-1), showed an almost complete association of ALC Ki-1⁺ lymphomas and HD cases with EBV. The neoplastic cells of both these LMs also showed common immunophenotypic features such as frequent absence of B- and T-cell differentiation markers and expression of the Ki-1 activation marker, while SNCC and LCI lymphomas were mainly of mature B-cell origin and Ki-1^-. The concomitant high incidence of ALC Ki-1⁺ lymphomas and HD in a specific group of HIV⁺ patients, their almost complete association with EBV in clonal and episomal form and the great similarity in differentiation, activation and virological markers which they display suggest that these LMs are pathological variants of a continuous spectrum of HIV-1-associated disorders etiopathologically linked to EBV.     

An outbreak of Salmonella hadar associated with food consumption at a building site canteen

A biphasic outbreak of gastroenteritis caused by Salmonella hadar affected canteen employees and workers at a construction site in central Italy in September 1994. There were 448 symptomatic cases, from 61 of whom group C Salmonella was isolated. Six cases were canteen employees. Twenty-two other individuals were asymptomatic excreters. There were 10 secondary cases. Working as a food handler at the canteen constituted an increased risk of infection, independently of ingestion of the food (odds ratio: 62.1; 95% confidence interval (CI): 9.5– 406.6). Having eaten at the canteen on the 19th and 20th September was identified as risk factor for subjects symptomatic within 72 hours (relative risk (RR): 17.0, 95% CI: 2.3–124.3), and cooled meat salad was identified as the vehicle of infection (RR: 36.6, 95% CI: 14.3–93.8). The use of portable toilets was another possible route of transmission of infection for all cases (RR: 1.3, 95% CI: 1.0–1.6). The index case was a cook who had symptoms five days before the peak of the outbreak. From 27 individuals both symptomatic and asymptomatic excreters group B, group D and not-typed Salmonellas were isolated. This study underlines the problem of improper food handling in salmonellosis outbreaks and emphasizes the role of several vehicles in the transmission of salmonellosis in a community.     

Prophylactic fenoldopam for renal protection in sepsis: a randomized, double-blind, placebo-controlled pilot trial

OBJECTIVE: Acute renal failure is common in septic patients. Fenoldopam, a dopamine-1 receptor agonist, increases renal blood flow and may, therefore, reduce the risk of acute renal failure in such patients. Accordingly, we sought to determine the safety and efficacy of fenoldopam for the prevention of acute renal failure in septic patients. DESIGN: Prospective, double-blind, placebo-controlled trial. SETTING: Three multidisciplinary intensive care units at a university hospital. PATIENTS: Three hundred septic patients with baseline serum creatinine concentrations <150 micromol/L. INTERVENTIONS: We randomized patients to a continuous infusion of either fenoldopam (n = 150) at 0.09 microg x kg x min or placebo (n = 150) while in the intensive care unit. The primary outcome measure was the incidence of acute renal failure, defined as a serum creatinine concentration increase to >150 micromol/L, during study drug infusion. MEASUREMENTS AND MAIN RESULTS: The incidence of acute renal failure was significantly lower in the fenoldopam group compared with the control group (29 vs. 51 patients; p = .006). The odds ratio of developing acute renal failure for patients treated with fenoldopam was estimated to be 0.47 (p = .005). The difference in the incidence of severe acute renal failure (creatinine >300 mumol/L), however, failed to achieve statistical significance (10 vs. 21; p = .056). The length of intensive care unit stay in surviving patients was significantly lower in the fenoldopam group compared with the control group (10.64 +/- 9.3 vs. 13.4 +/- 14.0; p < .001). There were no complications of fenoldopam infusion. A direct effect of treatment on the probability of death, beyond its effect on acute renal failure, was not significant (odds ratio = 0.68, p = .1). CONCLUSIONS: Compared with placebo, low-dose fenoldopam resulted in a smaller increase in serum creatinine in septic patients. The clinical significance of this finding is uncertain. A large multiple-center trial is now needed to confirm these findings.